Virtual Reality and Exposure Therapy

The most essential feature of VR is its ability to simulate what is not real. This is its core concept, and what causes its radical exclusivity and novelty. The benefits of ‘avoiding reality’ in this sense, is most often that virtuality is more cost-effective than reality. For instance, corporations worldwide train their employees in VR as it saves money to avoid renting a physical location and hiring physical trainers. ‘Money’ in this case, is of course just a measure of effectivity: it takes less resources to achieve certain objectives virtually than physically. The cost is not the only benefit, however; the virtual may also be safer. We see this especially within surgery, where a failed operation on a virtual patient is much preferred than on a real one.

Exposure TherapyAnother scenario where virtuality may be preffered is psychological treatment of anxiety disorders. Anxiety is a terrible disorder in the way it is eating away the lives of the sufferers, and is hard to treat to by non-addictive pharmaceutical medicine. Psychological treatment, however, is in general very successful towards certain anxiety disorders. Agoraphobia, arachnophobia, glossophobia, etc., can be treated by what we call “exposure therapy”.

Under exposure therapy, the patient usually get together with a psychologist, and is asked to express their fears of the situation of exposure. Here they answer what they think will happen, and how they think they will react. Their fears are pinpointed, and their catastrophic thinking is outlined. In these cases, it is not uncommon that patients believe they will literally stop breathing, or die, etc.: the narrative which operates is something they buy heavily in to, and the key of exposure therapy is to challenge their acceptance of this narrative. To a certain extent, this is a central problem of anxiety disorders: patients very seldom challenge these fears, of obvious reasons, and so their map of how the world works is not challenged and updated by reality. This is, through exposure therapy, systematized.

When the patient has been exposed to their fear scenario — the psychologist confront the patient with their initial fears that were written down prior to the exposure. The patient is then encouraged to reflect on the gap between their fears and what actually happened, something which we refer to as inhibitory learning. This kind of treatment falls under what is depicted as Cognitive Behavioral Therapy (CBT); by actively challenging the patients’ mental model of the world by reflection on facts.

Long story short — exposure therapy works. The largest problem with exposure therapy is, as usual, the cost. Having highly educated psychologists dedicated to the task is expensive enough in itself — but arranging the exposure to a fear scenario is an often greater challenge, practically and economically. It is not really convenient to summon spiders into the psychologist’s office, for instance. Arranging complicated fear scenarios and executing them is not convenient, and at high cost, which is a hinder for an otherwise effective treatment.

Virtual Reality Exposure Therapy can be used to treat, for instance, arachnophobia (fear of spiders). If you are not afraid of spiders, you might need to increase their size. I can recommend trying Farpoint for PSVR, which features giant space spiders similar to those in this illustration by Alphonse de Neuville.

Virtual Reality Exposure Therapy
This is where the concept of VR enters our story, as we start talking of Virtual Reality Exposure Therapy (VREP). By using virtual environments instead of actual physical locations, effective exposure therapy can be offered to more people at lower cost. At the University of Bergen, through the research project INTROMAT, we develop and do research on VR Exposure Therapy for adolescents with fear of public speaking. The INTROMAT project aims to introduce personalized treatment of mental health problems using adaptive technology. Currently, we are working on a very exciting approach to this, which Matrise will cover in more detail later.

The question that often raises itself when we discuss the concept of VRET, is whether we can fear what we know is not real. Although we know what it is like to be nervous before talks, it is perhaps hard to imagine being afraid of speaking in front of virtual subjects in which ‘nobody’s home’. On this point, however, the research is very clear. As Lindner et. al (2017) writes, “decades of research and more than 20 randomized controlled trials show that [VRET] is effective in reducing fear and anxiety”. The reason why VRET is interesting now, today, is then not necessarily because VR is finally good enough to deliver realistic virtual scenarios. VRET has been shown to be effective with VR technologies far inferior to those setups we have commercially available today. The reason for its relevance as a research subject now, is because the technologies are finally cheap enough to successfully be used in large scale treatment. It is therefore time to revisit the previous research, and look at how this treatment can be improved further.

This is why INTROMAT now is looking at new ways of improving and investigating ‘state of the art VRET’.